Aiden Stein was taken into the hospital at the age of 5 months with massive brain damage and other injuries suggestive of child abuse. His father, who was alone with Aiden at the time of Aiden's injuries, could be charged with murder, and Aiden's mother remains engaged to the father. Because Aiden is permanently unconscious, his physicians recommended that he be taken off life support, a recommendation that was also supported by the hospital ethics committee. The ethics committee also recommended appointment of a guardian to make Aiden's medical decisions, because both of his parents had a substantial conflict of interest due to the serious criminal charges that could result from Aiden's death. The trial court appointed a local nurse-attorney as the child's guardian for the limited purpose of making medical decisions, including decisions about life-supporting treatments.

Last Thursday, a unanimous Ohio Supreme Court ruled that a guardian could be given the power to make life-and-death decisions only if the parental rights of the child's parents had been terminated, which has not happened. The court's reason, in brief, can be gleaned from these excerpts:

“The fundamental liberty interest of natural parents in the care, custody, and management of their child does not evaporate simply because they have not been model parents or have lost temporary custody of their child to the State. Even when blood relationships are strained, parents retain a vital interest inpreventing the irretrievable destruction of their family life. If anything, personsfaced with forced dissolution of their parental rights have a more critical need for procedural protections than do those resisting state intervention into ongoing family affairs. When the State moves to destroy weakened familial bonds, it must provide the parents with fundamentally fair procedures.” Santosky v. Kramer (1982), 455 U.S. 745, 753-754, 102 S.Ct. 1388, 71 L.Ed.2d 599.

We conclude that the probate court’s order authorizing the guardian to withdraw life-supporting treatments has the effect of terminating parental rights. We, therefore, hold that the probate court exceeded its statutory authority in granting the guardian the power to withdraw life-supporting treatments before the parents’ rights were permanently terminated. . . .

The heartbreak and tragedy in this case cannot be overstated. However, we believe that without a full and proper adjudication of parental rights concluding in a termination of those rights, a probate court has no authority to allow a guardian to make a decision that will terminate the life of a child, when parental rights have not been permanently terminated, thereby terminating the parent-child relationship. . . .

The case is In re Guardianship of Stein, __ Ohio St.3d __, 2004-Ohio-7114 (Dec. 30, 2004) (PDF). Although formally a statutory interpretation case, the citation to the U.S. Supreme Court clearly demonstrates the Ohio court's belief that a narrow statutory interpretation was needed to avoid an unconstitutional result. Thus, the implications of this decision go well beyond the court's reading of the Ohio guardianship law.

The result reached by the court is also at odds with standard practice in many states when dealing with parents who cannot or will not participate meaningfully in end-of-life decision making. Temporary and limited guardianships are frequently ordered by local courts for the sole purpose of making medical decisions for the incompetent patient, without going through a full-blown termination-of-parental-rights process. The Ohio Supreme Court's opinion suggests that -- whatever the statutory issues may be in another state -- empowering a guardian to make a decision to withdraw or withhold life-sustaining treatment without first terminating the parents' rights violates the federal constitution. [tm]